RESUMO
The Coronavirus 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has resulted in unprecedented morbidity and mortality worldwide. While COVID-19 typically presents as viral pneumonia, cardiovascular manifestations such as acute coronary syndromes, arterial and venous thrombosis, acutely decompensated heart failure (HF), and arrhythmia are frequently observed. Many of these complications are associated with poorer outcomes, including death. Herein we review the relationship between cardiovascular risk factors and outcomes among patients with COVID-19, cardiovascular manifestations of COVID-19, and cardiovascular complications associated with COVID-19 vaccination.
Assuntos
COVID-19 , Insuficiência Cardíaca , Humanos , Vacinas contra COVID-19 , COVID-19/complicações , COVID-19/epidemiologia , SARS-CoV-2 , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , PandemiasRESUMO
BACKGROUND: Messenger RNA (mRNA) coronavirus disease of 2019 (COVID-19) vaccine are known to cause minor side effects at the injection site and mild global systemic symptoms in first 24-48 h. Recently published case series have reported a possible association between acute myocarditis and COVID-19 vaccination, predominantly in young males. METHODS: We report a case series of 5 young male patients with cardiovascular magnetic resonance (CMR)-confirmed acute myocarditis within 72 h after receiving a dose of an mRNA-based COVID-19 vaccine. RESULTS: Our case series suggests that myocarditis in this setting is characterized by myocardial edema and late gadolinium enhancement in the lateral wall of the left ventricular (LV) myocardium, reduced global LV longitudinal strain, and preserved LV ejection fraction. All patients in our series remained clinically stable during a relatively short inpatient hospital stay. CONCLUSIONS: In conjunction with other recently published case series and national vaccine safety surveillance data, this case series suggests a possible association between acute myocarditis and COVID-19 vaccination in young males and highlights a potential pattern in accompanying CMR abnormalities.
Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Imagem Cinética por Ressonância Magnética/métodos , Miocardite/diagnóstico por imagem , Doença Aguda , Adulto , Coração/diagnóstico por imagem , Coração/fisiopatologia , Humanos , Masculino , Miocardite/fisiopatologia , Valor Preditivo dos Testes , SARS-CoV-2 , Adulto JovemRESUMO
IMPORTANCE: There has been limited research on patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19. OBJECTIVE: To compare characteristics, treatment, and outcomes of patients with STEMI with vs without COVID-19 infection. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of consecutive adult patients admitted between January 2019 and December 2020 (end of follow-up in January 2021) with out-of-hospital or in-hospital STEMI at 509 US centers in the Vizient Clinical Database (N = 80â¯449). EXPOSURES: Active COVID-19 infection present during the same encounter. MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital mortality. Patients were propensity matched on the likelihood of COVID-19 diagnosis. In the main analysis, patients with COVID-19 were compared with those without COVID-19 during the previous calendar year. RESULTS: The out-of-hospital STEMI group included 76â¯434 patients (551 with COVID-19 vs 2755 without COVID-19 after matching) from 370 centers (64.1% aged 51-74 years; 70.3% men). The in-hospital STEMI group included 4015 patients (252 with COVID-19 vs 756 without COVID-19 after matching) from 353 centers (58.3% aged 51-74 years; 60.7% men). In patients with out-of-hospital STEMI, there was no significant difference in the likelihood of undergoing primary percutaneous coronary intervention by COVID-19 status; patients with in-hospital STEMI and COVID-19 were significantly less likely to undergo invasive diagnostic or therapeutic coronary procedures than those without COVID-19. Among patients with out-of-hospital STEMI and COVID-19 vs out-of-hospital STEMI without COVID-19, the rates of in-hospital mortality were 15.2% vs 11.2% (absolute difference, 4.1% [95% CI, 1.1%-7.0%]; P = .007). Among patients with in-hospital STEMI and COVID-19 vs in-hospital STEMI without COVID-19, the rates of in-hospital mortality were 78.5% vs 46.1% (absolute difference, 32.4% [95% CI, 29.0%-35.9%]; P < .001). CONCLUSIONS AND RELEVANCE: Among patients with out-of-hospital or in-hospital STEMI, a concomitant diagnosis of COVID-19 was significantly associated with higher rates of in-hospital mortality compared with patients without a diagnosis of COVID-19 from the past year. Further research is required to understand the potential mechanisms underlying this association.
Assuntos
COVID-19/complicações , Mortalidade Hospitalar , Hospitalização , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar , Pontuação de Propensão , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Estados Unidos/epidemiologiaRESUMO
There are limited contemporary data on readmission after revascularization for chronic mesenteric ischemia (CMI). This study aimed to determine the rates, reasons, predictors, and costs of 30-day readmission after endovascular or surgical revascularization for CMI. Patients with CMI discharged after endovascular or surgical revascularization during 2013 to 2014 were identified from the Nationwide Readmissions Database. The rates, reasons, length of stay, and costs of 30-day all-cause, non-elective, readmission were determined using weighted national estimates. Independent predictors of 30-day readmission were determined using hierarchical logistic regression. Among 4671 patients with CMI who underwent mesenteric revascularization, 19.5% were readmitted within 30 days after discharge at a median time of 10 days. More than 25% of readmissions were for cardiovascular or cerebrovascular conditions, most of which were for peripheral or visceral atherosclerosis and congestive heart failure. Independent predictors of 30-day readmission included non-elective index admission, chronic kidney disease (CKD), and discharge to home healthcare or to a skilled nursing facility. Revascularization modality did not independently predict readmission. In a nationwide, retrospective analysis of patients with CMI undergoing revascularization, approximately one in five were readmitted within 30 days. Predictors were largely non-modifiable and included non-elective index admission, CKD, and discharge disposition.
Assuntos
Procedimentos Endovasculares/efeitos adversos , Isquemia Mesentérica/cirurgia , Oclusão Vascular Mesentérica/cirurgia , Readmissão do Paciente , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Comorbidade , Bases de Dados Factuais , Feminino , Nível de Saúde , Humanos , Masculino , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Circulação Esplâncnica , Fatores de Tempo , Resultado do Tratamento , Estados UnidosRESUMO
Coronary artery fistulas (CAFs) are rare coronary anomalies involving the communication of an epicardial coronary artery and another cardiovascular structure. CAFs are usually easily distinguished from nearby coronary arteries. Here, we report a unique case of CAF that mimics the size, branching pattern, and appearance of a native epicardial left anterior descending artery.
RESUMO
The Coronavirus 2019 (COVID-19) pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, has resulted in unprecedented morbidity and mortality worldwide. While COVID-19 typically presents as viral pneumonia, cardiovascular manifestations such as acute coronary syndromes, arterial and venous thrombosis, acutely decompensated heart failure (HF), and arrhythmia are frequently observed. Many of these complications are associated with poorer outcomes, including death. Herein we review the relationship between cardiovascular risk factors and outcomes among patients with COVID-19, cardiovascular manifestations of COVID-19, and cardiovascular complications associated with COVID-19 vaccination.
Assuntos
COVID-19 , Doenças Cardiovasculares , Pneumonia Viral , COVID-19/complicações , Vacinas contra COVID-19 , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/etiologia , Humanos , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2RESUMO
Atrial fibrillation/flutter (AF) and COVID-19 are associated with an elevated risk of arterial and venous thrombosis. Whether preadmission oral anticoagulation (OAC) for AF reduces the incidence of in-hospital death or thrombotic events among patients with COVID-19 is unknown. We identified 630 patients with pre-existing AF and a hospitalization diagnosis of COVID-19 and stratified them according to preadmission OAC use. Multivariable logistic regression was employed to relate preadmission OAC to composite in-hospital mortality or thrombotic events. Unadjusted composite in-hospital mortality or thrombotic complications occurred less often in those on than not on preadmission OAC (27.1% vs 46.8%, p <0.001). After adjustment, the incidence of composite in-hospital all-cause mortality or thrombotic complications remained lower with preadmission OAC (odds ratio 0.37, confidence interval 0.25 to 0.53, p <0.0001). Secondary outcomes including all-cause mortality (16.3% vs 24.9%, p = 0.007), intensive care unit admission (14.7% vs 29.0%, p <0.001), intubation (6.4% vs 18.6%, p <0.001), and noninvasive ventilation (18.6% vs 27.5%, p = 0.007) occurred less frequently, and length of stay was shorter (6 vs 7 days, p <0.001) in patients on than those not on preadmission OAC. A higher CHA2DS2-VASc score was associated with an increased risk of thrombotic events. In conclusion, among patients with baseline AF who were hospitalized with COVID-19, those on preadmission OAC had lower rates of death, arterial and venous thrombotic events, and less severe COVID-19.
Assuntos
Fibrilação Atrial , Flutter Atrial , COVID-19 , Acidente Vascular Cerebral , Trombose , Administração Oral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Flutter Atrial/tratamento farmacológico , COVID-19/complicações , COVID-19/epidemiologia , Mortalidade Hospitalar , Hospitalização , Humanos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Trombose/epidemiologia , Trombose/etiologia , Trombose/prevenção & controleRESUMO
Preadmission statin therapy is associated with improved outcome in patients hospitalized with COVID-19. Whether inhibition of inflammation and myocardial injury are in part responsible for this observation has not been studied. The aim of the present study was to relate preadmission statin usage to markers of inflammation, myocardial injury, and clinical outcome among patients with established atherosclerosis who were admitted with COVID-19. Adult patients with a diagnosis of coronary artery disease, peripheral artery disease, and/or atherosclerotic cerebrovascular disease who were hospitalized with COVID-19 between March 1, 2020 and December 31, 2020 were included. Statin use was related to the primary composite clinical outcome, death, intensive care unit admission, or thrombotic complications in sequential multivariable logistic regression models. Of 3,584 adult patients who were hospitalized with COVID-19, 1,360 patients met study inclusion criteria (mean age 73.8 years, 45% women, 68% White). Baseline troponin and C-reactive protein were lower in patients on statins before admission. In an unadjusted model, preadmission statin usage was associated with a significant reduction in the primary composite outcome (42.2% vs 53.7%, odds ratio 0.63 [95% confidence interval 0.50 to 0.80], p <0.001). This association remained significant after age, gender, ethnicity, other patient clinical characteristics, and cardiovascular medications were added to the model but became null when troponin and C-reactive protein were also included (odds ratio 0.83 [95% confidence interval 0.63 to 1.09] p = 0.18). In conclusion, among patients with established cardiovascular disease who were hospitalized with COVID-19, preadmission statin therapy was associated with improved in-hospital outcome, an association that was negated once inflammation and myocardial injury were considered.
Assuntos
COVID-19 , Inibidores de Hidroximetilglutaril-CoA Redutases , Idoso , Proteína C-Reativa , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Inflamação , Masculino , Resultado do Tratamento , TroponinaRESUMO
We report a case of isolated cardiac sarcoidosis (CS) diagnosed using a multimodality imaging approach. A patient presented after an out-of-hospital, ventricular fibrillation-mediated cardiac arrest. The use of echocardiography, cardiac magnetic resonance, and fluorodeoxyglucose-positron emission tomography enabled the diagnosis of isolated CS. (Level of Difficulty: Beginner.).
RESUMO
Whether renal artery stenting (RAS) confers benefit over medical therapy (MT) alone in patients with atherosclerotic renal artery stenosis admitted with acute coronary syndromes (ACS), congestive heart failure (CHF), or hypertensive crisis remains unknown. We identified a nationally-weighted cohort of 116,056 patients from the Nationwide Readmissions Database with a preexisting diagnosis of atherosclerotic renal artery stenosis and an index hospitalization diagnosis of ACS, CHF, or hypertensive crisis, and propensity-matched on the likelihood of undergoing inpatient RAS. Thirty-day readmission rates, index hospitalization complications, hospital lengths-of-stay, and cost were compared between treatment groups. Overall, all-cause, nonelective 30-day readmission rates did not differ between RAS and MT alone (18.2% vs 18.7%, respectively, pâ¯=â¯0.49). RAS was associated with higher index rates of acute kidney injury, major bleeding, transfusion, and vascular complications, and were similar irrespective of index hospitalization diagnosis. Index hospitalization length of stay (6 vs 4 days; p <0.001) and cost ($23,020 vs. $11,459; p <0.001) were higher with RAS. In conclusion, nearly 1-in-5 patients hospitalized with atherosclerotic renal artery stenosis and ACS, CHF, or hypertensive crisis were readmitted within 30-days. Index hospitalization complications occurred more frequently among those treated with RAS than MT alone, but the likelihood of readmission did not differ by treatment strategy.
Assuntos
Tratamento Conservador/métodos , Procedimentos Endovasculares/métodos , Readmissão do Paciente/tendências , Obstrução da Artéria Renal/terapia , Artéria Renal/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: This study sought to determine whether higher maximal activated clotting time (ACT) during transradial (TR) percutaneous coronary intervention (PCI) is associated with greater bleeding risk. BACKGROUND: Higher maximal ACT during transfemoral (TF) PCI has been associated with a greater bleeding risk. It is unclear whether this relationship exists in the setting of TR PCI. METHODS: Among 14,637 patients undergoing TR or TF PCI with unfractionated heparin monotherapy, the study related maximal ACT to the risk of major bleeding. In secondary analyses, the study related maximal ACT to composites of in-hospital death, myocardial infarction (MI), or stroke and in-hospital death, MI, or urgent target vessel revascularization. Multivariable logistic regression was employed to compare outcomes in the third with the first and second maximal ACT tertiles. RESULTS: More major bleeding occurred at ACT >290 s versus ≤290 s following TF (7.7% vs. 5.8%; p = 0.006) but not TR PCI (1.7% vs. 2.4%; p = 0.18). After adjustment, major bleeding risk remained significantly higher at ACT >290 s versus ACT ≤290 s among TF (odds ratio: 1.28; 95% confidence interval: 1.02 to 1.62; p = 0.036) but not TR PCI (odds ratio: 0.72; 95% confidence interval: 0.42 to 1.22; p = 0.22). Maximal ACT was not related to the incidence of composite death, MI, or stroke or death, MI, or urgent target vessel revascularization following TF or TR PCI. CONCLUSIONS: Higher maximal ACT is associated with a greater risk of major bleeding following TF PCI than TR PCI.
Assuntos
Coagulação Sanguínea , Cateterismo Periférico/efeitos adversos , Artéria Femoral , Hemorragia/etiologia , Intervenção Coronária Percutânea/efeitos adversos , Artéria Radial , Idoso , Testes de Coagulação Sanguínea , Cateterismo Periférico/métodos , Cateterismo Periférico/mortalidade , Feminino , Hemorragia/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Rhode Island , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: This study sought to compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy with open surgery for chronic mesenteric ischemia (CMI). BACKGROUND: There are limited contemporary data on in-hospital cardiovascular outcomes among patients with CMI undergoing revascularization via endovascular therapy versus open surgery in the United States. METHODS: Patients with CMI undergoing endovascular or surgical (mesenteric bypass or endarterectomy) revascularization between 2007 and 2014 were identified from the National Inpatient Sample. Weighted national estimates were obtained. Primary and secondary endpoints were MACCE (death, myocardial infarction, stroke, cardiac post-operative complications) and composite in-hospital complications (MACCE + post-operative peripheral vascular complications, gastrointestinal hemorrhage, major bleeding, and bowel resection), respectively. Propensity score matching was used to obtain a balanced cohort of 880 unweighted patients in each group. RESULTS: Of 4,150 patients with CMI, 3,206 (77.2%) underwent endovascular therapy and 944 (22.8%) underwent surgery (weighted national estimates of 15,850 and 4,687, respectively). In the propensity-matched cohort, MACCE and composite in-hospital complications occurred significantly less often after endovascular therapy than surgery (8.6% vs. 15.9%; p < 0.001; and 15.3% vs. 20.3%; p < 0.006). Endovascular therapy was also associated with lower median hospital costs ($20,807.00 [interquartile range: $13,640.20 to $32.754.50] vs. $31,137.00 [interquartile range: $21,680.40 to $52,152.20]; p < 0.001, respectively) and shorter length of stay (5 [interquartile range: 2 to 10] vs. 10 [interquartile range: 7 to 17] days, respectively; p < 0.001) compared with open surgery. CONCLUSIONS: In a large, retrospective analysis of patients with CMI, endovascular therapy remained the dominant revascularization modality, and was associated with lower rates of MACCE, composite in-hospital complications, lower costs, and shorter length of stay compared with surgery.
Assuntos
Endarterectomia , Procedimentos Endovasculares , Isquemia Mesentérica/terapia , Oclusão Vascular Mesentérica/terapia , Enxerto Vascular , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Doença Crônica , Redução de Custos , Análise Custo-Benefício , Bases de Dados Factuais , Endarterectomia/efeitos adversos , Endarterectomia/economia , Endarterectomia/mortalidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/mortalidade , Feminino , Custos Hospitalares , Humanos , Pacientes Internados , Tempo de Internação , Modelos Logísticos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/economia , Isquemia Mesentérica/mortalidade , Oclusão Vascular Mesentérica/diagnóstico por imagem , Oclusão Vascular Mesentérica/economia , Oclusão Vascular Mesentérica/mortalidade , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Enxerto Vascular/efeitos adversos , Enxerto Vascular/economia , Enxerto Vascular/mortalidadeRESUMO
A 30-year-old, right-handed female presented 2 weeks postpartum with acute-onset severe headache, vertigo, and vomiting. Initial neurologic examination illustrated lingual dysarthria, horizontal nystagmus, right dysmetria on finger-to-nose testing, and weakness of the extremities. Magnetic resonance imaging showed a large, left lateral medullary infarction (Wallenberg syndrome) with cephalad extension into the ipsilateral pons as well as involvement of the left middle cerebellar peduncle. The patient was discharged 3 weeks later to an inpatient rehabilitation facility with gradual improvement of her symptoms.